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Update from Regional Measles & Rubella Laboratory Network, African Region

Accelerating Progress towards Measles & Rubella Elimination. Update from Regional Measles & Rubella Laboratory Network, African Region Hotel Royal, Geneva, Switzerland, 21-23 June 2016. Outline. Measles & rubella surveillance program Distribution of laboratories Main activities

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Update from Regional Measles & Rubella Laboratory Network, African Region

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  1. Accelerating Progress towards Measles & Rubella Elimination Update from Regional Measles & Rubella Laboratory Network, African Region Hotel Royal, Geneva, Switzerland, 21-23 June 2016

  2. Outline • Measles & rubella surveillance program • Distribution of laboratories • Main activities • Laboratory performance indicators • Detected genotypes • Main Challenges • Way forward

  3. AFR Measles Rubella Program • Measles elimination target by 2020 • Measles (M) or Measles & Rubella (MR ) SIAs going on in the Region : • WHO/AFR MR weekly partners updated by teleconference • CRS (congenital rubella syndrome) surveillance implemented in countries that have / are about to introduce rubella containing vaccine • Regular monitoring of surveillance performance indicators • Measles outbreaks: gaps in population immunity (low routine and SIAs coverage), and shift of epidemiological susceptibility to older age groups. • Measles verification process: not initiated yet

  4. Measles Surveillance Performance Indicators: AFR, 2010-2016

  5. Distribution of MR Laboratories • N=49 labs • Newly established: SEY & MAS • One lab/country except NIE (4) & ETH (3) • No lab: EQG, STP, CAV • Funding: MR initiative National Lab Sub National Lab Regional Ref. Lab

  6. Implementation of internal/external quality control system Training (bench work & data management) Weekly lab data reporting & analysis Monitoring of performance indicators & ensuring follow up actions Strengthening quality assurance Accreditation reviews & lab annual directors meeting WHO support: kits, basic supplies, funds for operationnal cost Main Lab. AFR Network Activities

  7. Laboratory Training conducted, 2015-16 Above training was conducted in Eastern & Southern Africa

  8. Main Laboratory Performance Indicators

  9. Workload at laboratory East Southern labs tested highest number of specimens. Of the 3 RRLs, IPCIV received the least number of specimens

  10. Timeliness & Completeness in Sharing Database Suboptimal completeness & timeliness in sharing database on a weekly basis due to challenges in internet connectivity, competing activities

  11. IgM Results Turn Around Time Stock out of kits adversely affected this indicator especially in 2016

  12. 2015 Measles & Rubella Proficiency Test Reporting by website submission: challenging for some labs, ultimately used old system

  13. Lab. Accreditation Exercises Accreditation process by desk review (correspondence): to be selectively intensified in 2016

  14. Recent Measles Outbreaks • Ethiopia – 2015 and 2016 (throat swabs collected- B3 genotype) • Nigeria – 2015 (59 throat swabs collected- B3 genotype) • DR Congo – 2016 (54 throat swabs collected- B3 genotype) • Uganda – 2015 (73 OFs and 14 throat swabs – B3 genotype) • Sierra Leone – early 2016, Liberia • Namibia – 2015, Equatorial Guinea – 2015 and 2016 • Gabon – early 2016 (12 throat swabs collected- B3 genotype)

  15. Measles Genotype Identified: 2005-2016* • Identified from specimens collected from outbreak & QC • Sequencing lab: NICD,UVRI, IPCIV & CDC • B3 genotype largely circulating (In 2016 identified in DRC, GAB, NIE & TOG) • Submission on MeaNS done B3 B2 D4 D2 D10

  16. 1st Report of Rubella genotype 2B in West Africa (IPCIV) Branch of rubella genotype 1G tree: contains sequences from CIV, Ghana, and Nigeria Branch of rubella genotype 2B tree: contains sequences from DRC, Burundi, and India

  17. Main Challenges • Suboptimal weekly reporting timeliness/completeness • Internet connectivity problems • Competing laboratory activities • Regular stock out of measles & rubella kits • Lack of reagents for PCR & sequencing activities • Insufficient /inadequate coordination between lab & surveillance • Missed opportunity to collect specimens for virus isolation/genotyping

  18. Main Challenges (cn’t) • Suboptimal collection of specimens for virus detection and logistics for it • Refusal from DHL carrier to carry blood specimens since Ebola outbreak event (West & Central Africa) • Insufficient funds to cover lab activities • To purchase kits, sequencing reagents/supplies, consumables • To organize trainings, • For lab operations

  19. Way Forward • Advocate for additional funding for the lab network - 2,4 Millions USD needed per annum • Strengthen collaboration between lab & surveillance to monitor for outbreaks and allow timely collection of specimens for genotyping • Complete accreditation reviews • Additional training on rubella sequencing needed by CIV RRL • Secure alternative carriers to transport specimens for QC

  20. Acknowledgements • NLs & Surveillance teams • 3 RRLs • WHO/HQ • CDC

  21. Reported progress on completion of GAPIII, Phase I Phase 1 completed Planned PEF EMRO Countries

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